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Cost-effectiveness Modeling of Intrathecal Baclofen Therapy Versus Other Interventions for Disabling Spasticity

Department of Physical Medicine and Rehabilitation, Groupe Hospitalier R. Poincaré-Hôpital Maritime de Berck, AP-HP, Versailles-Saint Quentin University, Garches, France

A.B. Ward, BSc, FRCPE, FRCP

North Staffordshire Rehabilitation Centre, The Haywood, Stoke on Trent, United Kingdom

J. Wissel, MD

Neurological Rehabilitation Hospital, Beelitz-Heilstätten, Germany

F. Motta, MD

Department of Paediatric Orthopaedics, V. Buzzi Children's Hospital, Milan, Italy

Leopold Saltuari, MD

Oesterreichisches Landeskrankenhaus Hochzirl; Neurologische Akutnachsorge Abteilung; Hochzirl; Austria

J. Lissens, MD

Medtronic International, Tolochenaz, Switzerland

S. Cros, PharmD

Medtronic International, Tolochenaz, Switzerland

A. Beresniak, MD, PhD

LIRAES-Paris Descartes University, Paris, France, Data Mining International, Geneva, Switzerland,aberesniak{at}datamining-international.com

Objective. To assess by simulation the cost-effectiveness of intrathecal baclofen (ITB) therapy compared with conventional medical treatments for patients with disabling spasticity and functional dependence caused by any neurological disease. Methods. Two models were created to simulate therapeutic strategies for managing severe spasticity, one with and one without the use of ITB, to assess various treatment sequences over 2 years based on current medical practices in France. Successful treatment at each evaluation was defined as a combination of: (1) the increased patient and caregiver satisfaction as assessed by goal attainment scaling (GAS), and (2) a decrease of at least 1 point on the Ashworth score. Probabilistic sensitivity analyses were performed using 5000 Monte-Carlo simulations taking into account specific distribution curves for direct costs and effectiveness parameters in each treatment option. Results. The model simulations suggest that including ITB as a first option strategy in the management of function of severely impaired patients with disabling spasticity results in a higher success rate (78.7% vs 59.3%; P < .001). In addition, the ITB therapy model revealed a lower cost (59 391 vs 88 272; P < .001) and an overall more favorable cost-effectiveness ratio (75 204/success vs 148 822/success; P < .001), compared with conventional medical management without ITB. Conclusion. Within the assumptions of our modeling, ITB therapy evaluated by a combination of treatment success criteria at 6-month intervals over a 2-year period may be a cost-effective strategy compared to conventional medical management alone.

Key Words: Cerebral palsy • Multiple sclerosis • Spinal cord injury • Rehabilitation • Spasticity • Baclofen • Models (economic)

This version was published on July 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 6, 546-552 (2009)
DOI: 10.1177/1545968308328724


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